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ID REVIEW > Ticks, Mites, and Lice > Flashcards

Ticks, Mites, and Lice Flashcards

1
Q

Lyme Disease vector and geography

A

Ixodes tick

NE and MW USA

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2
Q

The Ixodes tick also serves as the vector for . . .

A

Lyme

Anaplasmosis

Babesiosis (Babesia microti)

Borrelia miyamotoi, (fever and meningoencephalitis)

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3
Q

When treating Lyme w/ Doxycycline offers the advantage of treating possible . . .

A

Anaplasma phagocytophilum.

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4
Q

Dx of CNS-Lyme infection . . .

A

Positive results on serologic testing

Intrathecal antibody production or B. burgdorferi PCR on CSF

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5
Q

Erythema migrans W / O travel to an area endemic for Lyme disease.

A

Southern tick–associated rash illness (STARI)

Results of labs testing for B. burgdorferi are invariably negative

Most prevalent in SE and SC USA

Disseminated infection has not been documented.

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6
Q

Babesiosis infects . . .

A

erythrocytes

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7
Q

Babesia microti is transmitted by . . .

A

Ixodes tick

and cases by transfusion of infected blood products

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8
Q

High risk patients w/ higher Babesia parasitic burdens . . .

A

Asplenia or those who are

older patients

Immunocompromised

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9
Q

Babesia lab findings and blood smear

. . .

A

Laboratory findings are related to hemolysis

Transaminitis and thrombocytopenia are also common.

Giemsa or Wright staining, Trophozoites appear as ring forms inside erythrocytes (may be confused with malaria)

Protozoa may resemble a tetrad or Maltese cross formation.

PCR is a more sensitive test

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10
Q

Treatment for babesiosis . . .

A

Mild - mod disease: atovaquone plus azithromycin

Severe disease: clindamycin plus quinine

Exchange transfusion can be considered

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11
Q

The vector for ehrlichiosis (HME) and geography . . .

A

Lone Star tick,

Endemic to the southcentral and southeastern of US

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12
Q

Laboratory abnormalities raising suspicion for HME and HGA ?

A

Leukopenia + thrombocytopenia.

Transaminitis w/ normal bili and AlkP

Morulae, basophilic inclusion bodies composed of clusters of bacteria, may be found in leukocyte cytoplasm

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13
Q

Tx for HME and HGA ?

A

Doxycycline

Treatment options are limited, so desensitization may be required.

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14
Q

Consider diagnosis of RMSF:

A

Any patient with a fever and possible tick exposure regardless of the presence of a rash

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15
Q

Dx of acute RMSF

A

Immunohistochemistry or PCR of a skin biopsy

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16
Q

Tx for RMSF

A

Doxycycline;

Contraindicated in pregnancy; chloramphenicol is an alternative option

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17
Q

• Scrub typhus

A

• Orientia tsutsugamushi

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18
Q

• Louse-borne relapsing fever

A

• Borrelia recurrentis

19
Q

• Tick-borne relapsing fever

Ornithodorus ticks

A
  • Borrelia hermsii

* Borrelia turicatae

20
Q

• Boutonneuse (Mediterranean) fever

A

• Rickettsia conorii

21
Q

• Louse-borne epidemic typhus

A

• Rickettsia prowazekii

22
Q

• Endemic (murine) typhus

A

• Rickettsia typhi

23
Q

American Boutonneuse Fever

Skin findings and pathogen

A

Rickettsia parkeri
Lone Star or Gulf Coast ticks

  • Faint salmon-colored rash
  • Single or multiple eschars
24
Q

African Tick Bite Fever

A

Rickettsia africae

  • Clusters of cases, multiple eschars
  • Incubation period 6-7d
25
Q

Rickettsialpox

A

• R. akari

Vector • Mouse mites

  • Single eschar
  • Rash 20-40 papulovesicles
26
Q

Scrub Typhus

• O. tsutsugamushi

A

Vector • Trombiculid mite (chiggers)

• Triangle Japan - Australia - Russia

  • Eschar, painful/draining lymph nodes, rash, delirium
  • May progress to multiorgan system failure
27
Q

If I say “flying squirrel”

A

You say “epidemic typhus” or “R. prowazekii”

28
Q

Typhus: Two Forms

A

Epidemic - R. prowazekii

Endemic - R. typhi

29
Q

Epidemic Typhus - R. prowazekii

A

Louse (body, head)

War refugees, crowded conditions/poor hygiene

Lethal

30
Q

Pearl: most common cause of blood transfusion related parasite infection in US

A

Babesia microti

PCR for Dx

31
Q

Tickborne Relapsing Fever US pearls . . .

A
  • mainly B. hermsii
  • Elevation 1500-8000 feet
  • Can be severe : ARDS
  • Spirochetes seen in blood smear
  • Jarisch Herxheimer reaction in 54%
32
Q

Louse-borne Relapsing Fever (LBRF) pearls . . .

A

Borrelia recurrentis

Vector: Human body louse

(Refugee camps, famine, natural disasters)

33
Q

Borrelia miyamotoi

A

Epidemiology = Lyme disease

see in in Minnesota and Wisconsin

34
Q

Tick-borne viruses

A
  • Powassan (Deer Tick Virus Lineage II, flavivirus)
  • Colorado tick fever (colitvirus)
  • Heartland virus (phlebovirus) = HME
  • Bourbon virus (?)

and

• Tularemia

35
Q

RMSF Rash:

A

Can appears after several days of fever and viral-like prodrome

36
Q

• Blood smear: may be helpful in

A
  • Morulae: PMN = Anaplasma, Monocyte = Ehrlichia
  • Spirochete: relapsing fever Borrelia or B. miyamotoi
  • Erythrocyte inclusions: Babesia
37
Q

• Rodent infested urban house:

A

• Rickettsialpox

38
Q

Lyme Borreliosis

A

Europe

• Borrelia afzelii & Borrelia garinii&raquo_space;

39
Q

Erythema migrans: classic and MoCo

A

Most common: homogeneous, pink-red ovoid

> 5cm = more secure diagnosis

40
Q

Late Lyme disease (3): Dermatologic

A

Acrodermitis chronica atrophicans (Europe) (foot?)

Borrelia Lymphocytoma (Europe) (ear?)

41
Q

Diagnostics: Lyme arthritis

A

Synovial fluid:
o 10,000-25,000 WBC
o PMN predominant
 Borr burg PCR

• Serology: ~100% (+) in blood
 High titer, Bb IgG immunoblot

42
Q

• Second generation B. Burgdorferi Ab assays:

A

C6 or VlsE (variable major protein-like sequence expressed)

 Better at detecting B. garinii, B. afzelli (Europe)

43
Q

Treatment: Late Lyme arthritis

A

• Initial treatment: x 28d
 If lack of response: second course

• ~10% do not respond to repeated antibiotic therapy = Abx-refractory Lyme arthritis
oAutoimmune phenomenon,

 Treatment: DMARDs, intra-articular corticosteroids, synovectomy

44
Q

I. scapularis tick bite prophylaxis

A

Doxy *200 mg given with 72h of tick bite

ID REVIEW (25 decks)

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